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Avatar Cal-PM 2024 Update 9

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2024 Monthly Release 2024.00.00
RADplus 2024 Monthly Release 2024.00.00

Product Update Description

An issue is resolved where an undefined error may occur when running the 'Eligibility Response(271)' report.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Eligibility Response (271) - Compile Eligibility Inquiry (270) Request
Resolves an issue to ensure that the Eligibility Inquiry (270) Request compiles successfully using 'Eligibility Response (271)' form. KB0076227 v0.01
Topics
• Eligibility Response (271) • NX
 
Acceptance Tests
AV-94906 Summary | Details
Eligibility Response (271) - Compile Eligibility Inquiry (270) Request
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Eligibility Response (271)
  • Eligibility Inquiry and Response (270/271) Report
Scenario 1: Eligibility Response (271) - Compile 271 eligibility response file based on 270 request.
Specific Setup:
  • System must be setup to create a 270 request for the client/service.
  • Registry Setting:
  • The 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets' registry setting is set to 'Y'.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. All the required information for the eligibility inquiry and response are populated correctly on the '270 / 271 / 834' section of the form. Note the guarantor's code/name.
  • Guarantor/Program Billing Defaults:
  • All the fields required to compile 270 request and 271 response data are populated correctly for the template that contains desired program and the guarantor.
  • Service codes:
  • An existing service code is identified to be used. The 'Service Type Code (270)' is set up with the desired value. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Client Charge Input:
  • A service is rendered to the client using the service code identified above. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the assigned guarantor.
  • Close the charges.
  • Eligibility Inquiry (270) Request:
  • An Eligibility Inquiry (270) request is created for a client.
  • A 271 eligibility response file is created based on the information found on the Eligibility Inquiry (270) Submission. Note the path of the location where the 271 response file is located.
Steps
  1. Open the 'Eligibility Response (271)' form.
  2. Load the 271 eligibility response file created in the setup section.
  3. Verify the file loads successfully.
  4. Compile the loaded 271 eligibility response file.
  5. Verify the file compiles successfully.
  6. Select 'Response Data' option from the report.
  7. Verify the system displays data correctly.
  8. Post the compiled 271 eligibility response file.
  9. Verify the file posts successfully.
  10. Open the 'Crystal report' or any other SQL Data Viewer.
  11. Query the billing_271_sub_elig and billing_271_dep_elig tables.
  12. Verify that the data_entry_utc field is present in the table.
Scenario 2: Eligibility Inquiry and Response (270/271) Report field validation
Steps
  1. Open 'Eligibility Inquiry and Response (270/271) Report'.
  2. Enter the 'Client ID' for the client that will not be rejected.
  3. Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT-4 Code' field.
  4. Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
  5. Close the form.
Topics
• Eligibility Response (271) • NX
Table Changes
Table Column Change
billing_271_resp service_type_value %CC changed to {FACILITY}
billing_271_sub_elig service_type_value %CC changed to {FACILITY}
billing_271_sub_elig data_entry_utc added
billing_271_dep_elig service_type_value %CC changed to {FACILITY}
billing_271_dep_elig data_entry_utc added